Prevalencia y caracterización de la sobrecarga del cuidador primario de pacientes al final de la vida / Prevalence and characterization of overload of the primary caregiver of patients at the end of life

Introducción: El objetivo del presente estudio fue determinar la prevalencia de la sobrecarga del cuidador primario de pacientes al final de la vida que acuden al servicio de urgencias de este hospital y determinar sus características sociodemográficas. Pacientes y métodos: Se realizó un estudio de tipo observacional, descriptivo y prospectivo; se incluyeron 264 cuidadores principales de pacientes que se encontraban en la fase final de la vida, quienes recibieron atención médica por complicaciones de su patología de base en el servicio de urgencias del Hospital General de México “Dr. Eduardo Liceaga”, en un periodo de 6 meses, del 1 de abril de 2021 al 31 de septiembre de 2021, con los siguientes criterios de inclusión: ser el cuidador principal, tener un lazo familiar con un enfermo, con participación voluntaria, tener más de 18 años de edad. Los participantes, previa firma del consentimiento informado, contestaron los cuestionarios de datos demográficos, escala de Zarit abreviada, escala de Katz. Dentro de la valoración multidimensional del paciente con enfermedad terminal, la valoración biológica es fundamentada por la situación funcional del enfermo; para valorar la dependencia para las actividades de la vida diaria se puede emplear el índice de Katz. Resultados: Se incluyeron 264 cuidadores primarios, 187 (70,8 %) fueron del género femenino y 77 (29,2 %) del género masculino; la edad mínima fue de 18 años y máxima de 80 años, con una mediana de 44 años. Del total de cuidadores analizados 219 (83 %) presentaban sobrecarga del cuidador en el momento de la entrevista. De los sujetos estudiados, 138 (52,3 %) eran cuidadores únicos, de los cuales más de la mitad (57 %) padecían sobrecarga del cuidador. (AU)

Introduction: The objective of this study was to determine the prevalence of overload among the primary caregivers of patients at the end of life who attended the emergency department of this hospital, and to determine their sociodemographic characteristics. Patients and methods: An observational, descriptive and prospective study was carried out, including 264 main caregivers of patients who were in the final phase of life, who received medical care for complications of their underlying condition in the emergency department of the General Hospital of Mexico “Dr. Eduardo Liceaga” over a period of 6 months, from April 1, 2021 to September 31, 2021, with the following inclusion criteria: being the main caregiver, having a family relationship with the patient, voluntary participation, being more than 18 years old. The participants, after signing an informed consent, completed the demographic data questionnaires, the abbreviated Zarit scale, and the Katz scale. Within the multidimensional assessment of the terminally ill patient, the biological assessment is based on the patient’s functional status; to assess dependence on activities of daily living, the Katz index can be used. Results: A total of 264 primary caregivers were included, 187 (70,8%) were female and 77 (29,2%) were male; the minimum age was 18 years and the maximum age was 80 years, with a median of 44 years. Of the total number of caregivers analyzed, 219 (83%) presented caregiver collapse syndrome at the time of the interview. Of the subjects studied, 138 (52,3%) were sole caregivers, of which more than half (57%) suffered from caregiver collapse syndrome. (AU)

Subacute transverse myelitis as a clinical presentation of neurobrucellosis.

Brucella melitensis is the main cause of human brucellosis worldwide and is considered the most virulent and neurotropic species. In Mexico, this species is considered endemic, being reported since the first decade of the 20th century. Here we present a case of subacute transverse myelitis with the isolation and identification of B. melitensis as the causative agent of Neurobrucellosis in a female patient from the coastal state of Guerrero, Mexico.

Perception and Beliefs Regarding Cardiovascular Risk Factors and Lifestyle Modifications Among High-Risk College Students.

BACKGROUND: Studying risk factors and corresponding behavior in young adults is important as atherosclerotic plaque begins to form in early adulthood, resulting in cardiovascular disease (CVD) later in life. The purpose of this study was to explore the perceptions and beliefs regarding cardiovascular risk and lifestyle modification among high-risk college students (based on Framingham 30-year risk score). METHODS: Semistructured qualitative interviews were conducted and analyzed using qualitative content analysis. RESULTS: Risk factors included overweight/obesity, alcohol consumption, elevated blood pressure, family history, and smoking. Qualitative interviews revealed six themes: (a) recognizing risk, (b) lifestyle trajectories, (c) factors influencing lifestyles, (d) ideal healthy lifestyle modifications, (e) perceived benefits of healthy lifestyles, and (f) integrating technology and health apps. Participants demonstrated a lack of understanding of how the various factors contributed to CV risk. Influencing factors to a healthy lifestyle were categorized as environmental, relational, financial, work/life/school balance, and internal/intrinsic motivation. CONCLUSIONS: Understanding high-risk college students' beliefs and perceptions regarding CVD risk factors and lifestyle modification is the first step to assessing the problem facilitating early intervention in the young adult population. Clinicians should assess, develop, and implement risk reduction programs that are tailored to individuals who need it the most, those at high risk.

The Neutrophil-to-Monocyte Ratio and Lymphocyte-to-Neutrophil Ratio at Admission Predict In-Hospital Mortality in Mexican Patients with Severe SARS-CoV-2 Infection (Covid-19).

There is a deep need for mortality predictors that allow clinicians to quickly triage patients with severe coronavirus disease 2019 (Covid-19) into intensive care units at the time of hospital admission. Thus, we examined the efficacy of the lymphocyte-to-neutrophil ratio (LNR) and neutrophil-to-monocyte ratio (NMR) as predictors of in-hospital death at admission in patients with severe Covid-19. A total of 54 Mexican adult patients with Covid-19 that met hospitalization criteria were retrospectively enrolled, followed-up daily until hospital discharge or death, and then assigned to survival or non-survival groups. Clinical, demographic, and laboratory parameters were recorded at admission. A total of 20 patients with severe Covid-19 died, and 75% of them were men older than 62.90 ± 14.18 years on average. Type 2 diabetes, hypertension, and coronary heart disease were more prevalent in non-survivors. As compared to survivors, LNR was significantly fourfold decreased while NMR was twofold increased. LNR ≤ 0.088 predicted in-hospital mortality with a sensitivity of 85.00% and a specificity of 74.19%. NMR ≥ 17.75 was a better independent risk factor for mortality with a sensitivity of 89.47% and a specificity of 80.00%. This study demonstrates for the first time that NMR and LNR are accurate predictors of in-hospital mortality at admission in patients with severe Covid-19.

Exploring Pain Management Among Asian Immigrants with Chronic Pain: Self-Management and Resilience.

Asians immigrants (AIs) are one of the fastest growing racial groups in many countries globally. Despite pain prevalence, studies on chronic pain management among AIs is limited in the literature. An integrative review was conducted exploring the current state of science on chronic pain management among AIs. Several databases were used to identify related articles and 15 studies met the inclusion criteria. Two major themes emerged: (a) self-management, pertaining to how AIs take responsibility for their pain, and (b) resilience, their adaptive behaviors indicating low levels of pain-related dysfunction and burden despite chronic pain severity. Resilience plays a significant role in the mechanism by which self-management works in pain among AIs. Chronic pain management is a complex process where challenges to effective treatments exist. Findings have significant implications to healthcare providers and the general pain population. Future research directions include the necessity for increased participation of AIs in studies.

Applying an information literacy rubric to first-year health sciences student research posters.

OBJECTIVE: This article describes the collection and analysis of annotated bibliographies created by first-year health sciences students to support their final poster projects. The authors examined the students' abilities to select relevant and authoritative sources, summarize the content of those sources, and correctly cite those sources. METHODS: We collected images of 1,253 posters, of which 120 were sampled for analysis, and scored the posters using a 4-point rubric to evaluate the students' information literacy skills. RESULTS: We found that 52% of students were proficient at selecting relevant sources that directly contributed to the themes, topics, or debates presented in their final poster projects, and 64% of students did well with selecting authoritative peer-reviewed scholarly sources related to their topics. However, 45% of students showed difficulty in correctly applying American Psychological Association (APA) citation style. CONCLUSION: Our findings demonstrate a need for instructors and librarians to provide strategies for reading and comprehending scholarly articles in addition to properly using APA citation style.

Resilience, Acculturative Stress, and Family Norms Against Disclosure of Mental Health Problems Among Foreign-Born Filipino American Women.

The present study explores the relationships between resilience, acculturative stress, and family norms against disclosure of mental health problems among foreign-born Filipino American women. The sample consisted of 159 foreign-born Filipino American women aged 18 years and above and residing in Las Vegas, Nevada, United States. Participants completed paper-and-pencil questionnaires. Results indicated high levels of resilience and moderate levels of acculturative stress. Findings also showed a significant negative correlation between resilience and acculturative stress, and a significant predictive effect of resilience on acculturative stress. We also found a significant negative relationship between resilience and family norms against disclosure of mental health problems but no significant mediating effect of resilience on the relationship between acculturative stress and family norms. This lack of significant findings related to the mediating effect of resilience on the relationship between acculturative stress and family norms against disclosure of mental illness may be due to the absence of theoretical models and research regarding the role of resilience in the context of acculturation among Filipino American women. Our findings imply the need to further explore underlying mechanisms that explain the relationships between resilience, acculturative stress, and family norms. The findings of the study also confirm the need to develop interventions and resources that ameliorate acculturative stress and promote an increase of the disclosure and reporting of mental health problems among Filipino American women.

Exploring Challenges in Conducting E-Mental Health Research Among Asian American Women.

In this discussion paper, we explore the challenges of conducting e-mental health intervention research among Asian American women and propose a model for addressing these barriers. Based on an extensive literature review, we identify two main types of barriers to conducting e-mental health intervention research among Asian American women: recruitment barriers and adherence barriers. Recruitment barriers are further subcategorized into those related to (1) stigmatized cultural beliefs about mental illness and mental health services; (2) lack of awareness about mental health services; and (3) language barrier. As to adherence barriers, the two identified subtypes concern (1) acuity and severity of mental health condition; and (2) lack of time. In order to enhance recruitment and adherence in e-mental health intervention research among the studied population, we formulate the following three main research strategies, namely: (1) considering the cultural and social contexts of Asian American women in the development of e-mental health interventions; (2) determining appropriate program length; and (3) conducting feasibility studies to test e-mental health interventions. We suggest that nurse researchers integrate our proposed model in conducting e-mental health interventions among Asian American women. Our proposed model also implies that nurses play an important role in encouraging Asian American women's acceptance of and adherence to e-mental health interventions. In order to overcome the obstacles to conducting e-mental health research among Asian American women, we recommend that nurses familiarize themselves with credible, relevant, and evidence-based e-mental health resources and integrate online mental health services and information within their nursing practice.